Y. Zager1, A. Dan1, Y. Nevo1, L. Barda1, M. Guttman1, Y. Goldes1, A. Nevler1 1Sheba Medical Center,Surgery B,Ramat-gan, ISRAEL, Israel
Introduction:
Gastric cancer is the fifth most common cancer worldwide. This aggressive gastrointestinal cancer has grim 5 year survival rates of only 30% and is considered the third leading cause of cancer deaths worldwide. Studies in recent years have found hematological markers such as Neutrophil to Lymphocyte ratio (NLR) as potent prognostic immune biomarkers in various malignant conditions including gastric adenocarcinoma (GC). However, chemotherapy has been shown to affect systemic immune responses and local immune signatures and thus, may affect NLR. We therefore aimed to assess the prognostic value of using post-neoadjuvant NLR as a biomarker in gastric cancer patients with resectable disease.
Methods:
We conducted retrospective analysis on a prospectively maintained GC database in our institution. We collected oncologic, perioperative and survival data regarding gastric adenocarcinoma patients that underwent curative intent gastrectomy and D2 lymphadenectomy between the years 2010-2015. Neutrophil-to-Lymphocyte ratio were calculated from preoperative laboratory test. High and low NLR groups were stratified using NLR≥4 as a threshold. Kaplan-Meier analysis and Cox multivariate regression models were used for survival analysis to assess the prognostic value of clinical, histologic and hematological variables.
Results:
We reviewed the data of 174 patients, of which 121 (70%) patients we had the complete necessary data. median follow up duration was 20 months (range 1-88). A total of 54 patients received neoadjuvant chemotherapy (NACT). Postoperatively, High NLR was associated with greater morbidity (ranked with the Clavian-Dindo classification, p=0.011). The rate of major complications (Clavien-Dindo≥3) was higher significantly in the high NLR group (31.25% vs. 5.77%, p=0.015).
Among patients that received NACT, patients in the low NLR groups has a significantly improved disease free survival (Mean DFS, 48.9±5.4 months vs 27.7±10.0 months, p=0.04). Low NLR was not significantly associated with overall survival (OS). Multi-variant analysis demonstrated NLR (p=0.018, HR= 33.7%, CI = 0.12-0.947), and AJCC staging (p=0.01) to be independent prognostic factors associated with DFS.
Conclusion:
Our results suggests that NLR may have prognostic value amongst gastric cancer patients planned for curative intent surgery who underwent NACT. These effects are evident mainly in terms of disease free survival and perioperative complications. Further studies assessing the value of NLR in predicting chemotherapy response are on their way.
